Ask the Assessor - the Core Competencies

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• Robert // Aug 9, 2007 at 10:58 pm

  When should I start studying for the Quarterly Assessments? I started my pre-reg two weeks ago and I already know the dates of my first and second assessments!

• Peter Chapman // Aug 10, 2007 at 12:01 pm

  Hi Robert
  My tip is to start as soon as possible. Like all revision programs it is a good idea to have some structure. There are two ways you could do this…
  1. Study a topic/topics a night - this way each time you have completed one you have the sense of achievement
  2. Study what you saw - As you will be aware this is partly an evidence based assessment and you have to see certain types of cases for each assessment. At your next study time, revise the case types you saw in practice. i.e. if you had a aptient who needed prism in their spectacles, study prism and associated areas (competency 4.1).

  Way1 offers more structure but way 2 keeps the topics more real and you are able to relate the theory you learn to a real case.

  For the assessment you can revise as much or as little as you want but as you never really know what the assessor will ask, more is better so start early!

  P.S My top tip - Be organised and complete the log book by the end of each day. It is a nightmare trrying to fill it in 2 months later before the assessment!!

• Joy Myint // Aug 15, 2007 at 6:05 am

  Robert,

  Start now!! Don’t be surprised that you have the dates of your first two assessments. Many assessors book all the quarterly assessments at the inital visit.

• Robert // Sep 13, 2007 at 11:59 pm

  Thanks guys.

• KS // Sep 14, 2007 at 12:02 am

  My first assessment is coming up soon. My assessor want me to go through a full routine. Any tips? I am seeing about 4 patients a day at the moment and I am really really slow.

• Jane Macnaughton // Sep 17, 2007 at 11:46 am

  4 patients a day when you have just started sounds about right. You should try to increase this gradually to perhaps 8 by Christmas?
  What is useful is to break the year down into quarters, months, weeks, days etc. and make plans to increase this number gradually throughout the year so that you achieve your minimum refraction episodes (and dispensing) ahead of time. Plan also to factor in the various types of patient episodes you need to see, such as diabetic, BV, children etc and make this list known to those who are responsible for your clinic diary so that opportunity doesn’t pass you by and go to another optom instead.
  I would certainly advocate having someone watch you occasionally. It need not be you supervisor (although he/she should probably watch you occasionally), but if you have another pre-reg working near you, why don’t you arrange to sit in as a subject for each other - you will be surprised how useful that can be.
  And finally, there is a one hour online audio lecture with accompanying slides available on this site - dedicated entirely to the Routine Exam both for the Q Assessments and the Final assessment exam.
  All the best, J

• Raul // Nov 4, 2007 at 12:37 pm

  Hello everyone,

  just had a couple of questions regarding the quarterly assessments…..
  1-is there a fixed time limit or can we have more time if we need for example if 2 of the competancy groups have not been assessed because time is approaching 3 hours does the assessor have to stop the assesmnet or should they extend the time to allow for this
  2- if we dont have a particular patient episode can we still pass it by answering questions and case scenarios related to that core competency?

  Thanks guys

• Jane Macnaughton // Nov 4, 2007 at 1:37 pm

  1-The time limit is 4 hours. It will not be in your interest to push beyond this time as both you and your Assessor will be tired and concentration will be poor. Many Assessors will have another trainee to visit on the same day and so will terminate the assessment. It is not unusual, however, to have a couple of competencies deferred due to lack of time although a couple of competency groups would be unusual!
  2 - This will vary upon the actual competency. Refer to the patient episode sheets in your manual. If a competency statement asks for ‘at least one’ of or ‘at least three of’ then if you have not seen any at all, it is unlikely that you will achieve the competency. If a patient episode is requested then you should be making the effort to achieve that experience.
  One or two competencies will be questioned or assessed through role play or case scenarios. However, this type of evidence is considered the ‘weaker’ form of evidence. If you have patient records then this is considered ’stronger’ evidence. The stronger your evidence, the better your position in the final assessment, if it all goes a bit wrong the day. The Assessment board looks at how you evidenced the competencies for the QA’s when you have failed one in the FA.
  My tip would be to make sure you get the experience rather than rely on role play. Look at the patient episode sheets and inform whoever it is responsible for booking your clinic list. Make a huge effort to gain the patient episodes wherever possible. Indeed, if you do not, then the Assessor will ask you to seek them out anyway.

  Good Luck.

• Raul // Nov 4, 2007 at 3:16 pm

  Thanks for the reply
  I asked the initial questions because i feel slightly short-changed after my 1st assesment which lasted for just about 3 hours. My assessor had yet to assess competency groups 5 and 6 before he said our time was up and i should carry these to the second quarter. Even though i had enough evidence to present he did not have time to see them. He also did not pass on 5.9 (VF analysis) because i didnt present a case record of a patient with a VF defect and he did not offer any alternatives to passing this competency.
  Should I feel slightly hard done by or does this sound “normal” in your opinion.

• Jane Macnaughton // Nov 5, 2007 at 12:38 am

  If you feel that you have been short-changed in any way, then first of all talk to the assessor directly to understand why. Often there are additional reasons behind those decisions taken. Terminating at three hours is not uncommon and although there is a four-hour limit that may not mean that the assessor must keep going until the four hours is up.

  Regarding 5.9. The patient episode sheet doesn’t ask for an episode of a VF defect however, neither does it say anywhere that you must be assessed with plots that an assessor has brought along; there are several ways through which this competency could be assessed (DO, PR, logbook, Q). As this competency is split into two sections; the ability to investigate and the ability to manage (analyse and interpret), how well did you do on the ability to investigate? For example, an assessor may not assess on the management if the investigation had already been covered and was found to be weak.

  First of all, the entire process is recorded in your assessment report forms, a copy of which is sent on to the College for their own records. The form will set out the objectives (further action agreed) of those competencies you have failed to achieve, in time for a review at the next quarterly assessment.
  In signing this form you are agreeing to the outcomes of the form. For example, it may state ‘must show one case of a VF defect for next visit’. If you are not happy, and that you feel that you are unable to achieve any of the objectives listed by the Assessor (or of you feel that they are ‘unfair’), then don’t sign the form until you are. You, the assessor and your supervisor must discuss the assessment together and come to the decision unanimously. So, for example, if you feel that you have an argument to say that you should be assessed with VF plots then this should be addressed in your discussion with the assessor and supervisor. .

  If after discussion with the assessor and the supervisor you are sill unhappy, then talk directly to the senior assessor at your local level. Good luck.

• Joy Myint // Nov 5, 2007 at 1:26 am

  I feel that I need to reiterate and back-up Jane’s comments here. The 4-hour time limit is a maximum time, and to be fair after about 3 hours both the pre-reg optom and the assessor are often flagging. The 4 hours also includes all the feedback time.

  It is not uncommon for competencies to be deferred. There are, after all, 33 competencies to assess in the first visit, which is a lot. The number of competencies decreases with each visit so an assessor may elect to “even out” the spread a little to make it more manageable. A deferral of a competency is not a fail so the pre-reg should not feel disheartened.

  For each competency an assessor will look for at least three different evidence forms to pass. This may be a patient record, a case scenario and a field plot as an example. If the candidate demonstrates weakness with e.g. the first part of a two part competency the assessor may not spend a great deal of time (if any) on the second part, as this would be unfair if the pre-reg has already “failed”.

  If any pre-reg is unhappy with the outcome of an assessment, they should discuss it with the supervisor to see if they agree, then approach the assessor directly. Don’t just send the forms back unsigned - talk to the assessor. Using the Senior Assessor should be a last resort.

  The scheme is set up to allow flexibility for all parties and the systems are in place for the scheme to be fair to all. Talk to your assessors- if they do not know you are unhappy they cannot rectify it.

• bryony // Jun 5, 2008 at 3:38 am

  hi, Im about to fit my finals, but thought i would offer some encouragement to those about to start pre-reg.
  1. Start studying asap. It can be dull and repetative… but they will ask you about those petty things you often feel are a bit irrelevant, because at some point you will find it was relevant after all! Also studying from the offset means its better spread out… The hardest thing is time, working full time and studying is difficult, so spread the load. Also if you are studying you will be less likely to look stupid infront of a px, cos you’ll know what you are talking about!
  2. Assessments come round quickly, so be prepared. The 1st and second contain a lot of competencies, so don’t worry if some are left untouched, or are failed. The 3rd has just 19 and I don’t know of anyone who passed everything in 3 sittings. I know i didnt. Its normal.
  3. Take your time. In the exams you get 40 mins for a px. DO NOT LET EMPLOYERS PUSH YOU TOO HARD. If you start rushing, you’ll get lazy, and either fail things, or have to re-learn a good routine. I take a full 30 mins per sight test and have now been testing a year. Practise makes perfect, but letting yourself get lazy is stupid. Many multiples test on 20 mins slots, I would say even if later on you think you can do this, don’t until you’ve passed finals. (even when i’ve passed i wont be reducing my appointment times).
  Finally, I really reccommend getting a routine with your supervisor to help you. Love my supervisor… but didnt get much time with him. Arrange half an hour on a regular basis to discuss interesting/difficult px and to ask questions. Make sure they watch you work so if you are falling into bad habbits they catch you and hopefully help you put it right.
  Pre-Reg has been blood sweat and occasional tears, but keep at it and it will be worth it. Good luck, and appologies for taking up so much ‘wall space’!

• Sara // Oct 23, 2008 at 4:27 pm

  Hi everyone!!
  just a few questions.
  1, why do we do VF test on px with H/A? what are we looking out for?when would the case be referred.
  2, my assessment is in 10 workinging days, but the practice i work in is very quiet and on averarge i see 2 px a day, and do 1 dispense a day. Im very stressed about the low numbers(58 refractions), i cant study or sleep. many of my friends manage 7 px in a morning.wat can i do?? the staff refuse to book appointments for me, i ask my supervisors px’s who are often not perpared (car parking) for the longer sight test i do.
  any advise??

• Jane Macnaughton // Oct 27, 2008 at 5:14 am

  Hi Sara (Oct 23)
  Headaches may be a symptom of neurological disease or accident (e.g raised intracranial pressure, space occupying lesions, cerebral accident etc) many of which will also have associated vf defects. For this competency you must have detailed knowledge of the vf pathway, associated structures (vascular system, pupil pathway fibres, surrounding anatomical features etc) and understand what happens when something goes wrong (e.g lesion to the optic tract, lesion to the Meyer’s Loop, space occupying lesion in the pituitary fossa, etc.) . Know also the patient’s signs (vf defect, pupillary defect) and symptoms (headache, nausea, vomiting). Understand what type of defect that may or may not result from each lesion and how you would investigate it (choice of programme, target, machine). Only when you understand the cause can you set about discussing your management criteria (including referral criteria).

  The second point is a little more difficult. First you must sit down with your supervisor and make the time to discuss this in detail. Whilst 7 in a morning sounds rather a lot (even I would struggle)2 in a day does fall short at this stage in your year. You may find, of course, that your supervisor has this in hand and may be giving you two a day before increasing you gradually. Either way, if you are in any way concerned, your must talk to your supervisor first. Ideally you should have a plan that spreads over the entire year so that you can break down each month and have targets to see whether you are on track or not. If you haven’t already – then get a one year diary (wall calendar will do) and look at the time that you have over each month (look at holidays, including your supervisors absences) and set some targets. This target setting should also involve the clinic manager, or whoever is responsible for your daily clinic booking list. Interestingly, most patients love the additional time spent and are usually happy to sit for an hour (you will speed up through time) – perhaps you should review how this information is being passed to the patient who is booking the examination- shift the emphasis on the positive rather than the negative?
  If you are still falling short then your Assessor will flag this up in the assessment visit and talk to you both about it. If the practice has become quiet (let’s face it, some do ) then it is the responsibility of both you and your supervisor to obtain additional experience so that you achieve the right number of patient episodes.
  If you are not comfortable still – call your assessor – it’s also their job to listen to your worries and anxieties if you have been unable to resolve them internally. And finally, the Lead Assessor is very approachable if all else fails – she can be reached via the College.

• zara // Nov 7, 2008 at 1:36 pm

  hey where can i find a dicon ld 400 manual? i’d like to read up on how it worksand what the different programmes are for
  thanks

• Jane Macnaughton // Nov 10, 2008 at 2:56 am

  Hi Zara I have searched and searched with no success. I did manage to find one for the Henson 3200 which I have uploaded on the Resources Page.
  However, if you do not typically use the Dicon in your own practice, your Assessor will not expect this level of detail from you - they are only interested in your understanding of your own equipment. If you do have a Dicon then contact your supplier for a new manual - your Assessor would probably expect this 
  If your Assessor gives you an unfamilar visual field plot to discuss, then you should be able to look at it and work the defect out from first principles.
  In the meantime I shall do some more searching and see what we can come up with - unless anyone out there can assist us?

• feeling stupid // Feb 5, 2009 at 3:41 pm

  im a little confused, are RGP lenses stored in a disinfecting/cleaning soln overnight or in the conditioning soln?

• Joy Myint // Feb 10, 2009 at 3:29 am

  Dear “Feeling Stupid”. Conditioning solution

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